贝伐珠单抗联合化疗免疫治疗在放化疗后复发的非小细胞肺癌中的应用:病例报告。

Bevacizumab-Containing Chemoimmunotherapy for Recurrent Non-Small-Cell Lung Cancer after Chemoradiotherapy: Case Report.

机构信息

Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8031, Japan.

Department of Thoracic Surgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8031, Japan.

出版信息

Medicina (Kaunas). 2021 May 29;57(6):547. doi: 10.3390/medicina57060547.

Abstract

Chemoimmunotherapy has become the standard of care as the first-line treatment of advanced or recurrent non-small-cell lung cancer (NSCLC). The bevacizumab-containing chemoimmunotherapy regimen is theoretically more effective than a non-bevacizumab-containing regimen via two mechanisms: a superior outcome of bevacizumab-containing chemothrerapy than the standard platinum doublet regimen, and the synergistic effect of bevacizumab with an immune checkpoint inhibitor (ICI). Bevacizumab effectively normalizes vascularization, especially when the vascular bed is damaged by previous treatment. Bevacizumab promotes immunomodulation when used with ICI. We describe a patient with nonsquamous NSCLC who returned 2.5 years after definitive chemoradiotherapy for postoperative locoregional recurrence in the right supraclavicular lymph node. Considering the destroyed vascular bed due to prior chemoradiotherapy, attaining vascular normalization was critical for effective drug delivery. The patient was treated with a bevacizumab-containing chemoimmunotherapy regimen, which resulted in a complete metabolic response. The patient responded well for 23 months and is receiving ongoing treatment. Thus, bevacizumab-containing chemoimmunotherapy could be advantageous in some recurrent cases after chemoradiotherapy.

摘要

化疗免疫治疗已成为晚期或复发性非小细胞肺癌 (NSCLC) 的一线治疗标准。贝伐珠单抗联合化疗免疫治疗方案通过两种机制理论上比非贝伐珠单抗联合方案更有效:贝伐珠单抗联合化疗方案的疗效优于标准铂类双药方案,以及贝伐珠单抗与免疫检查点抑制剂 (ICI) 的协同作用。贝伐珠单抗可有效使血管正常化,特别是当血管床因先前的治疗而受损时。贝伐珠单抗与 ICI 联合使用时可促进免疫调节。我们描述了一名非鳞状 NSCLC 患者,在根治性放化疗后 2.5 年,右锁骨上淋巴结出现术后局部区域复发。考虑到先前放化疗导致的血管床破坏,实现血管正常化对于有效药物输送至关重要。该患者接受了贝伐珠单抗联合化疗免疫治疗方案,结果实现了完全代谢缓解。该患者在 23 个月内反应良好,并持续接受治疗。因此,贝伐珠单抗联合化疗免疫治疗在某些放化疗后复发的情况下可能具有优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a560/8226573/0d4cf6195b9d/medicina-57-00547-g001.jpg

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